conjugated estrogens vaginal cream, Premarin Vaginal Cream (cont.)

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Melasma--tan or brown
patches-- may develop on the forehead, cheeks, or temples. These may persist
even after the estrogen is stopped.

Conjugated estrogens may increase the
curvature of the cornea, and patients with contact lenses may develop
intolerance to their lenses.

Blood clots are an occasional, serious side effect
of estrogen therapy and are dose-related. (The higher the dose of estrogen, the
greater the risk of blood clots.) Cigarette smokers are at a higher risk than
non-smokers for blood clots, and patients requiring estrogens should be
encouraged to
quit smoking.

Estrogens can promote thickening of the lining of
the uterus (endometrial hyperplasia) and increase the risk of uterine cancer. At
diagnosis, endometrial cancers in recipients of estrogens are generally at an
earlier stage and are less aggressive when they are discovered. Survival from
endometrial cancer also is better in women taking estrogens than in those not
taking estrogens. The addition of a progestin to estrogen therapy offsets the
risk of endometrial cancer. Conflicting data exists on the association between
estrogens and breast cancer. There may be a small increase in risk. The effect
of concomitant progestin therapy on the risk of estrogen-induced breast cancer
is unclear. Conjugated estrogens are well-absorbed from the vagina and into the
blood. The amount absorbed depends on the frequency of use and the amount used.
Thus, more frequent use or larger amounts of vaginal estrogens can have effects
throughout the body (see conjugated estrogens, Premarin). The Women's Health
Initiative found that postmenopausal women (50-79 years old) taking conjugated
estrogens had an increased risk of breast cancer, blood clots, and stroke. There
was also an increased risk of impaired cognition and/or dementia among women
over age 65.